Social Support in Nursing - Literature review Example

Student’s Name] [Instructor’s Name] [Course Title] [Date] SOCIAL SUPPORT IN NURSING INTRODUCTION In the early years of the 20th century, social work's practice boundaries expanded to include direct work with people with the most serious mental illnesses through the function of aftercare. Using complementary and mutually reinforcing efforts to promote social reform in the care of people with mental illness and then to provide that care directly, the young social work profession established its presence in the emerging public mental health field and significantly broadened prevailing standards of acceptable care. In this paper I will explore the importance of social support in nursing. RATIONALE FOR CHOICE As the earliest form of "psychiatric" social work practice, aftercare functions became the vehicle for linking the emerging methods and tasks of social work with the existing structures of psychiatric care. That link proved to be an important one for widening the perspective on what constituted adequate care for people with the most serious mental illnesses, as well as for the definition and development of social work's professional turf. I believe that it is imperative to have support from the local community for clinical practices. Social support in nursing is an area that is now gaining considerable significance due to the important role that it plays in the well-being of people and the society in general. BRIEF HISTORY OF THE DEVELOPMENT OF SOCIAL CARE SUPPORT Social work practice with those who were labeled "insane" in the parlance of the early 20th century (individuals found to meet the legal definition of "insanity" at a "lunacy" court hearing and committed to institutions), arose from a socially progressive reform effort known as the aftercare movement. The rise of social work in public mental health through aftercare of people with serious mental illnesses illustrates the important reality that strengthening a profession takes place by creating turf, not just defending it (Barnes and Mercer, 2006, 45-8). This perspective thrives in unstable and shifting circumstances when prevailing definitions and boundaries are in flux. It is a useful perspective for the social work profession to confront the upheaval and uncertainty currently experienced in human services (Campbell, 2000, 95). From the 1906 establishment of an aftercare committee with a single social work-trained aftercare agent at New York's Manhattan State Hospital to 1930 when U.S. census data reported social workers employed in state mental hospitals in half of the states in the country, social work became identified with the function of aftercare. The processes that established this identification illustrate critical connections between social activism for an "idea" and the creation of professional "place." Such connections are important sources of professional legitimization through establishing what sociologist Andrew Abbott (1988) referred to as "jurisdictional claims" or assertions of specific links between a profession and its work (Barnes and Mercer, 2006, 45-8). CURRENT CLINICAL PRACTICES The sociology of professions provides multiple perspectives on professional development and functioning. Professions have been analyzed in terms of their essential characteristics, the function they serve in society, and even how useful they are (Braye, 1995, 77). A different perspective is obtained by asking how a given profession, in this case social work, came to be the profession that it is. Why did social work take hold in some settings and fields and not others? How did our professional "turf" get established in different arenas? In the case of social work, Wilcox argued that the essential task components that came to be considered social work had already been "laid out" by 1904, creating a certain sense of the profession's "work." Creation of the profession out of the work becomes a process of setting boundaries based on jurisdictional claim — staking out turf which is then labeled and, ultimately, acknowledged as social work (Barnes and Mercer, 2006, 21, 35). CURRENT SITUATION - PATIENT MENTAL HEALTH AS FIELD OF PRACTICE It is the constellation of these social work positions that constitute the patient health field of practice in social work. Prenatal, and pediatric social workers are doing front-line patient health work in hospitals and large medical clinics. In cases when physical, social, or emotional problems are identified, the medical social worker performs tasks such as assessing the mother's support system, promoting open communication between parent and medical staff, facilitating education and support groups, helping parents and their extended families express grief, supporting and coordinating child abuse cases, and referring parents to additional 2services such as homemaking assistance, addiction programs, and the Special Supplemental Food Program for Women, Infants, and Children (WIC). To remain positively engaged with an infant and family, the medical social worker must receive professional and personal support. Social work organizations such as the National Association of Perinatal Social Workers can facilitate a needed exchange of ideas and information and encourage professional networking. Burnout and depression can contribute to the patient health social worker leaving the job or even the field (Braye, 1995, 23-4, 55). Besides perinatal, neonatal, or pediatric social work, a number of other social work positions fall within the patient health field of practice. Social workers are employed in day care centers; therapeutic day care programs; community outreach programs designed to identify and engage isolated at-risk mothers; child welfare agencies; and family services agencies that provide parent education and parent support to vulnerable infants, mothers, and fathers. These social workers, basing interventions on infant development and attachment theory, focus on supporting the infant-in-family, for the family is the most effective and economical system for fostering the development of a child (Crees, Davis, 2005, 37-8). MENTAL HEALTH AS SOCIAL PRACTICE PERSPECTIVE Increased knowledge of the effects of early attachment problems on clients frequently suggests the roots of current difficulties. How well are the infants and children at home functioning? The application of the knowledge drawn from the field of patient health raises several implications for social work practice. The detailed study of infancy leads to an awareness of infants as communicating and vulnerable people (Golightley, 2006, 91). If the client is also a parent of small children, then the clinical focus expands to include the children, particularly in conditions in which the mother or father's ability to parent may be affected by her or his problems. Interdisciplinary practice that addresses the full range of parent-child needs and problems has the greatest probability of success. RESEARCH GUIDELINES AND POLICIES CARE PROGRAM APPROACH By the mid-1970s, there was much concern expressed about the problems of deinstitutionalization: increased stresses on families caused by patients' returning home to live, often without adequate community-based services; the continuing high admission rates to mental hospitals and escalating readmission rates; inadequacies of community care; lack of coordination between hospital and community-based services; lack of management systems to ensure adequacy and appropriateness of patient placement; inappropriate institutional placements (for example, nursing homes) for many patients; and the lack of coordination, planning, and priority setting on the national and state levels to address the needs of this population group. For many people with chronic mental illness, deinstitutionalization has meant being "dumped" into communities to live in single-room occupancy hotels, boarding homes, or apartments, often without adequate necessities of life and needed daily living supports (Foster, 2007, 36). In an attempt to address these issues at the federal level, in 1977 the National Institute of Mental Health developed the Community Support Program (CSP) as a model for providers of comprehensive, community-based services for people with chronic mental illness. The NIMH also made grants available to enable states to implement the model. The CSP is based on the premise that individuals with chronic mental illness need more than mental health services (Golightley, 2006, 64). To live successfully in the community, they also require non-mental health services such as assistance with daily living skills, housing, employment, socialization, finances, and medical care. The comprehensive service delivery approach of the CSP includes an emphasis on enhancing the social support systems of individuals with chronic mental illness. The conceptual model was based on theory and research indicating that the client's social network, in conjunction with a network of services, could help people with chronic mental illness adapt to community living (Golightley, 2006, 39, 84). A major thrust of this approach is to create a "network of caring" through a comprehensive system of case identification, outreach services, assistance in applying for entitlements, crisis-stabilization services, psychosocial rehabilitation, sheltered living arrangements, medical and mental health care, and backup support to family and friends. The CSP includes a focus on enhancing social supports by providing opportunities for people with mental illness to develop social skills and leisure activities as part of psychosocial rehabilitation. A central component of the CSP is the provision of case management services designed to directly address a major criticism of deinstitutionalization--that clients face a large, diverse, fragmented, and uncoordinated system of services that they often have difficulty negotiating on their own. The importance of case management to the social work profession is highlighted by a number of articles and books on this topic (Foster, 2007, 62). The importance of enhancing the social support networks of people with chronic mental illness was reaffirmed in 1986, when the Southern Regional Education Board published the results of an NIMH-funded study containing guidelines for assessing and improving the effectiveness of mental health case management personnel. The report cited the need for case managers to be knowledgeable about such informal support systems as churches, social clubs, self-help groups, families, and neighborhood leaders and to be skilled in mobilizing community resources for clients (Golightley, 2006, 29). In 1987 NIMH echoed the need for comprehensive support network intervention in a set of guiding principles for services to individuals with chronic mental illness that included the following statement: "Services should be normalized and incorporate natural supports. Services should be offered in the least restrictive, most natural setting possible. Clients should be encouraged to use the natural supports in the community and integrated, to the greatest extent possible, into the normal living, working, learning, and leisure time activities in the community" (Foster, 2007, 95) SOCIAL WORKERS ROLE-SERVICE DELIVERY AND IMPACT ON SERVICE USERS-PEOPLE WITH MENTAL HEALTH PROBLEMS People who use mental health services value common characteristics among those who work in those services, and (whilst there are numerous critical accounts of nursing care that can advise improved practice, service users do recognize the particular help that nurses can provide. Users of a rehabilitation service identified mental health nurses as providing practical help (cooking, cleaning, budgeting, dressing, bathing) caring (and continuing to care whatever they did), counseling (talking, chatting, social chit-chat), medication and liaison with other professionals. Although these users did not consider their `talk' with nurses to be particularly specialized, they did find it beneficial. This `ordinary' talking was also valued in a survey of 516 people who had all been admitted to psychiatric hospital on at least one occasion (and 120 more than six times) (Lynch, Kruzich, 2003, 15-8). Researchers reported that nurses were viewed more favorably than other mental health professionals (32.4% respondents said nurses had helped the most, and 59.4% were either satisfied or very satisfied with nursing care) (Lynch, Kruzich, 2003, 15-8). The quality of nursing care regarded most highly was talking, listening and ordinary relating; physical care and practical help; and, non-intervention or flexibility -- tolerating some rule breaking. Interestingly, student nurses were preferred as they engaged in seemingly genuine empathic relationships. It is this relationship that marks nurses -- as those professionals most often in closest contact, over longest periods, involved in more areas of their life and in different stages of distress and recovery -- as potentially different from other service providers. The question is, what nurses should do with and within that relationship (Repper, 2000, 33). Service users describe recovery as a process of making sense of what has happened to them, reconstructing a positive identity, accepting, living with and growing beyond the limits of their mental health problems. This is not something that can be `done to' a person, it is something that users must do for themselves: a deeply personal process that is unique to every individual. `... A matter of rising on lopped limbs to a new life'. (Lynch, Kruzich, 2003, 22) Service users value help with practical tasks in a manner that is sensitive to their wishes and culture -- such as sorting out housing problems, paying bills, choosing furniture. This work can improve their quality of life and give them a chance of being accepted within their community. Indeed, such work is often the way to engage and maintain contact with people who particularly resent having to use mental health services. It is also practical work with individuals (accompanying them to the pub, or church; negotiating sports activities or education; organizing employment experience) that is most effective at changing public attitudes (Lynch, Kruzich, 2003, 33-5). Whereas the effect of public education about mental illness appears to be limited, public attitudes appear to be more amenable to personal acquaintance with one person who has found ways of coping with their mental health problems INDIVIDUAL MODEL / MEDICAL MODEL A social model of disability asserts that people are disabled by economic, social and environmental barriers and by the (often unintentional) discriminatory practices and attitudes, which are still a feature of our society. It emphasizes enabling people to make choices, influence decisions and aspire to take control over their own lives. It also makes a distinction between impairment and disability (Marsh &Fisher, 1992, 71-8). A person may have functional impairments but these need not result in disability -- providing society accommodates and does not erect barriers to participation by stigmatizing or discriminating against that person. In the case of mental ill health, for instance, it is clear that society reacts adversely to the label in a way, which takes little, or no account of what a person who has the diagnosis can or cannot do in their lives (Marsh &Fisher, 1992, 71-8). Associating mental health problems with disability is contentious in that some, but not all users believe that accepting the 'disabled' label is merely exchanging one form of stigma for another. However, it is proposed in this paper that conceptually the disability model is more appropriate to address issues of access and the nature of the service to be provided. It also enables users to claim the rights and protection available under the DDA and to join the wider disability lobby in campaigning for greater rights and opportunities and in opposing benefits changes which force people into inappropriate employment (Marsh &Fisher, 1992, 71-8). PARTNERSHIP AND SOCIAL WORK – AN INSIGHT INTO USER INVOLVEMENT Having outlined the work of the group, we now turn to the context of the study in order to analyze the constraints and opportunities, which might account for the priorities set and the partial but incomplete success achieved. The opportunities for user-involvement have been created by three main factors: (1) Deinstitutionalization The run-down of the old large asylum system has placed more people with serious and long term mental health problems into community settings, such that the question of the citizenship of this client group is now a matter of concern for users themselves, as well as for those providing and managing mental health services (Oliver, Sappley, 2006, 151-8). Previously this question of citizenship was obscured by the mass segregation of psychiatric patients. With greater citizenship have come increased expectations of rights to good quality state- provided services (Oliver, Sappley, 2006, 151-8). (2) The legitimacy of bio-medical theory and practice and the rise of the users' movement The legitimacy of western psychiatric knowledge with a strong biological bias has been brought into question recurrently over the past 30 years, first from internal professional dissenters (so called 'anti-psychiatry'), then from clinical psychology and social psychiatry and, more recently, from disaffected service users. The latter have constituted one type of new social movement (such as feminism and the campaigning of physically disabled people), which has opposed traditional authority. (Oliver, Sappley, 2006, 151-8) (3) Consumerism In the British health care context consumerism has been an associated feature of an ideologically driven re-structuring of the welfare state. This has involved a separation of provider and purchaser functions and a policy emphasis on service provision having a triple source (public, private and voluntary sector) (Oliver, Sappley, 2006, 160-3). This shift has entailed one process of increased bureaucratization in the NHS (managerially) and one antibureaucratic process (development of quasimarkets). Managerialism places a value upon consumer feedback to increase service efficiency and the development of quasi-markets encourages a shift of accountability and involvement, albeit indirectly, to 'consumers'. (Oliver, Sappley, 2006, 164-5) A SERVICE EINTEGRATED APPROACH TO WILCOX’S MODEL Application of a service integration model to transition represents a potentially simpler, more focused variation of this concept, since each system involved (i.e., public schools, rehabilitation, and developmental disabilities) is responsible for the same employment and community living outcomes. However, for somewhat arbitrary or financially driven reasons, each system operates independently. It is the similarity in outcome responsibilities which suggests that integrating services across at least these three systems at the point of transition has strong potential for solving the long standing problem of unemployment for individuals with severe disabilities (Peplau, 2003, 98). If these services can be coordinated to respond to the interest and needs of individuals with disabilities and their families, community living and work outcomes are likely to improve. In order to implement a transition service integration model the public schools, developmental disabilities, and rehabilitation agencies need to enter into agreements to integrate services and jointly share the costs of those services (Peplau, 2003, 101-3). These agreements, fully operationalized during a student's final year in school, should: (a) plan the transition of students with severe disabilities into integrated community jobs; and (b) develop and implement individualized, personal recreation, leisure and community living plans. The public schools would maintain traditional service responsibilities and coordination prior to this last year, and the rehabilitation or developmental disabilities systems would continue to assume service responsibilities after an individual graduates or "ages out" of the public school system (Peplau, 2003, 130-5). The major impact of the service integration model would be changes in service and support responsibilities during the student's last year of school. It is anticipated that a transition service integration model would accomplish three important outcomes. First, it collectively leverages additional funds and resources at the point of transition, i.e., the student's final year in public school. Second, as will be illustrated later, it is an essentially cost neutral option for each participating system. Third, its organizational structure results in the elimination of the current discrepancy between the community settings, activities, and people providing natural and professional support during school, with those needed after graduation (Wood, 2002, 42). CONCLUSION People with mental health problems are no different. Neither a single profession, nor a single individual can provide every perspective, type of support, help or explanation that another person needs, nor should they try. However, mental health nurses are the natural allies of those people they seek to help. They can offer that consistent day-to-day relationship that can foster hope and growth. They can provide practical help to maintain or promote valued or desired relationships, roles and activities. They can also help service users to construct their own understanding of what has happened to them, but not by imposing a sense of order that is disconnected from the persons' own experiences and renders their own explanations inferior. None of these qualities are dependent upon a particular theoretical approach to mental health nursing; they may (or may not) be provided by whatever theoretical values the mental health nurse holds (Swain, French, Barnes, 2004, 61-4). Although the values underlying the `nurture' approach appear to reflect service users' wishes more closely, many skills offered by those practicing psychosocial interventions explicitly address areas of importance for service users. Service users value nurses for their `ordinariness' but this is no easy task. It demands extraordinary sensitivity, acute listening skills, a willingness to put oneself in the place of another, to be creative and flexible in proposing ways forward, yet prepared for such suggestions to go unheeded. There are times when service users want nurses to be less `ordinary' and more `professional' (Simons, 1992, 211). For example, to: help them understand the diagnosis that they have been given, the possible causes and prognosis; give information and support to achieve an acceptable level of medication; help them cope with their beliefs and voices; work with them to identify signs of relapse and develop plans to avert crises; plan ways of coping when crises do occur. Clearly both of the dominant `camps' in mental health nursing have a place. However, in addition to these skills -- which essentially involve changing the individual in some way -- mental health nurses need to work towards changing communities (Simons, 1992, 213). This requires intimate knowledge of community resources, an ability to work with family, friends and community agencies in a culturally appropriate and sensitive manner: strategies to create environments that enable people to live fulfilling lives. If mental health nursing is to meet the needs and wishes of service users it must fulfill multiple roles, provide multiple perspectives and promote social inclusion (that relies on the co-existence of a multitude of views and abilities). Rather than seeking an objective mental health nursing knowledge base that attempts to fix the world in a given way and allows us to act on those seeking help, we must embrace diversity within the practice, research and explanatory theories of our profession. 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Marsh P and Fisher M, (1992) Good Intensions: Developing Partnership in Social Services, Joseph Rowntree Foundation Oliver M and Sapey B, (2006) Social Work with Disabled People, 3rd edition, Palgrave, Macmillian, England Peplau, H. (2003). Psychiatric mental health nursing: Challenge and change. Journal of Psychiatric and Mental Health Nursing, Pilgrim and Rogers (2005), A Sociology of Mental Health and Illness, Open University Press Repper, J. (2000b). Social Inclusion and Community Integration. In T. Thompson & P. Matthias (Eds.), Mental Health and Disorder, 3rd Edition. London: Bailliere Tindall.. Simons K, (1994) Citizen Advocacy: The Inside View, Norah Fry Research Centre Bristol Swain J, French S, Barnes C and C Thomas (eds) (2004), 2nd edition, Disabling Barriers-Enabling Environments, Sage London Wood, H. (2002). Pulling Together: The Future Roles and Training of Mental Health Staff. London: Sainsbury Centre for Mental Health. Read More